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Claims Research Jobs (NOW HIRING)

Molina Healthcare

Analyst, Claims Research

Long Beach, CA · On-site +1

$19.84 - $38.69/hr

Job Summary Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of ...

Globalchannelmanagement

Collections Claims Clerk

Mason, OH · On-site

$21 - $22/hr

Research credits to determine whether there are two payments applied to the claim or if there is an ... Open claims with no payment, nor denial, see resubmit instructions. * If a claim has already been ...

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Guidewell

Claims Examiner I

Irving, TX · On-site

This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...

Guidewell

Claims Examiner I

San Antonio, TX · On-site

This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties ...

WebTPA

Claims Examiner I

Irving, TX · On-site

This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...

Guidewell

Claims Examiner I

San Antonio, TX

This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties ...

WebTPA

Claims Examiner I

San Antonio, TX

This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties ...

WebTPA

Claims Examiner I

Irving, TX

This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties ...

Guidewell

Claims Examiner I

Irving, TX

This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties ...

Guidewell

Claims Examiner I

Irving, TX · On-site

This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties ...

Franklin Billing Specialist

Be Seen First

Medical Claims Specialist

Franklin, TN · On-site

$15 - $35/hr

Track outstanding claims, research rejections, and file effective appeals to overturn denials. * Payer Follow-Up: Monitor aging AR reports and contact insurance companies to resolve unpaid claims.

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Claims Research information

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How much do claims research jobs pay per hour?

As of Jul 6, 2026, the average hourly pay for claims research in the United States is $24.12, according to ZipRecruiter salary data. Most workers in this role earn between $18.27 and $27.40 per hour, depending on experience, location, and employer.

What is the difference between Claims Research vs Claims Adjuster?

AspectClaims ResearchClaims Adjuster
Required CredentialsHigh school diploma or equivalent; some roles may require insurance certificationsHigh school diploma or equivalent; insurance licensing often required
Work EnvironmentOffice-based, research-focused, often involving data analysisField and office-based, investigating claims and interacting with clients
Industry UsageInsurance companies, third-party administrators, claims research firmsInsurance companies, adjusting firms, third-party administrators
Common Search & ComparisonYesYes

Claims Research involves analyzing data and gathering information to support claims decisions, often working behind the scenes. Claims Adjusters evaluate and settle claims directly with policyholders, often working in the field. While both roles require insurance knowledge and certifications, Claims Research focuses on data analysis, whereas Claims Adjusters handle claim investigations and settlements.

What are some common challenges faced in a Claims Research role, and how can they be managed?

A common challenge in Claims Research is navigating complex policy details and incomplete or ambiguous documentation. Researchers must often communicate with multiple stakeholders, such as policyholders, adjusters, and healthcare providers, to gather missing information and verify facts. Managing tight deadlines while ensuring accuracy is also crucial. Building strong organizational skills and maintaining clear, professional communication can help address these challenges effectively.

What are the key skills and qualifications needed to thrive as a Claims Research Specialist, and why are they important?

To thrive as a Claims Research Specialist, you need strong analytical skills, attention to detail, and knowledge of insurance or claims processes, often supported by a relevant degree or experience in claims management. Familiarity with claims management software, databases, and sometimes certification such as AIC (Associate in Claims) is typically required. Excellent communication, problem-solving abilities, and customer service skills help you excel when interacting with clients and resolving complex cases. These skills ensure accurate claim resolution, compliance with regulations, and a positive experience for policyholders.

What are claims research professionals?

Claims research professionals are specialists who investigate and analyze insurance claims to determine their validity and ensure compliance with policy terms. They gather information, review documentation, and may interview claimants or witnesses to verify details. Their work helps insurance companies prevent fraud, process legitimate claims efficiently, and resolve disputes. Claims researchers play a crucial role in protecting both the insurer and the policyholder by ensuring fair and accurate claim settlements.
More about Claims Research jobs
What are the most commonly searched types of Claims Research jobs? The most popular types of Claims Research jobs are:
What job categories do people searching Claims Research jobs look for? The top searched job categories for Claims Research jobs are:
Claims Research jobs near you
Analyst, Claims Research

Analyst, Claims Research

Molina Healthcare

Long Beach, CA • On-site, Remote

$19.84 - $38.69/hr

Full-time

Posted 9 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 192 frontline employees who took The Breakroom Quiz

143rd of 277 rated insurance

Job description


JOB DESCRIPTION Job Summary
Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution.
Essential Job Duties
• Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects.
• Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams.
• Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests.
• Assists with reducing rework by identifying and remediating claims processing issues.
• Locates and interprets claims-related regulatory and contractual requirements.
• Tailors existing reports and/or available data to meet the needs of claims projects.
• Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors.
• Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes.
• Seeks to improve overall claims performance, and ensure claims are processed accurately and timely.
• Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance.
• Works collaboratively with internal/external stakeholders to define claims requirements.
• Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing.
• Fields claims questions from the operations team.
• Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims.
• Appropriately conveys claims-related information and tailors communication based on targeted audiences.
• Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members.
• Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance.
• Supports claims department initiatives to improve overall claims function efficiency.
Required Qualifications
• At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience.
• Medical claims processing experience across multiple states, markets, and claim types.
• Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs.
• Data research and analysis skills.
• Organizational skills and attention to detail.
• Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Ability to work cross-collaboratively in a highly matrixed organization.
• Customer service skills.
• Effective verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency.
Preferred Qualifications
• Health care claims analysis experience.
• Project management experience.
#PJClaims
#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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